Violet-Anne Wynne (Clare, Independent) | Oireachtas source

I pay tribute to Councillor PJ Kelly. Everyone would say he had a mighty way with words. From every political determination, that is something they could at least agree on. I will never forget his words that you may put a gate at Lissycasey because there is nothing else past that in terms of funding and resources from Government. For that, he will always be remembered. I express my deepest sympathies to his family, friends and colleagues.

One in two people in Ireland will experience a mental health difficulty directly or indirectly. We all know this and many of us mentioned it in our contributions. This is a 164-page, 202-section Bill. After a thorough reading, I will reference some parts which were a missed opportunity. I am aware that the Government has indicated there are a number of amendments it hopes to bring forward and that it was not possible to include all recommendations by the committee on previous Stages. In respect of the recent south Kerry CAMHS scandal, for example, it is tempting to be glad that the office of the chief inspector position will inspect each centre at least once every five years but the lack of an independent system for service users or their parents to make complaints makes it hard to see this as a complete victory for patients. I find that omission glaring, if I may be so bold as to say that. I hope it will be addressed, as one might think this Government is almost afraid to allow patients the respect and dignity they deserve by ensuring there is a mechanism to complain with ease and have their voices heard without fear of repercussion from the very service they so desperately need. This issue was brought to the forefront thanks to the fantastic work of the Families for Reform of CAMHS, which indicated that an awful lot of its members - I believe 35% - felt they suffered in some way once a complaint was submitted. When that was brought to light, it should have set the foundation for all Departments to consider that there must be a pathway for recourse and communication and for patients to seek a resolution to their concerns. That must be best practice, at the least, when going forward.

Although this Bill covers many issues to do with children in the mental health system, there is no mention of the problem of children being admitted to adult inpatient beds. Children spent 217 days in adult psychiatric institutions due to a lack of children's beds in 2022. In that year, there were 72 child inpatient beds. This was cut to 51 and by March this year, it was down to 30 due to staff shortages. For a Bill which provides for the involuntary admission of children to and discharge from registered acute mental health centres, this feels like another glaring omission. However, it is not like passing the legislation would be a guarantee that the Government would be able to follow it. I say this with the greatest of respect and the knowledge that there may be a different government coming in. It is well known by service users that an assessment of need, for example, can take up to two years to procure despite the requirement under the Disability Act that it take a maximum of six months. With this in mind, the Government appears over-optimistic in preventing An Garda Síochána from administering involuntary admissions to psychiatric care. We know the Garda is overworked. A Garda station is not an appropriate place to receive anything but the most urgent healthcare. It undeniably reflects poorly on our mental health service that 30% of involuntary admissions last year came through An Garda Síochána. However, I do not see any framework in this Bill to put the pressure which we know is placed on An Garda Síochána anywhere else.

That must be addressed and I hope it will be by the incoming amendments.

As regards the long-standing issue of gardaí making 30% of the applications for involuntary admissions, the Bill removes Garda powers to involuntarily admit someone for mental health treatment but still gives the Garda the ability to involuntarily detain people in custody for up to 18 hours pending assessment. The Bill proposes to solve that by giving greater powers to authorising officers but I have to make the point that the HSE is already understaffed. I received this information through a recent parliamentary question response. There are 1,377 whole-time equivalent nursing positions vacant in UHL and 133 permanent vacancies as of August this year.

Mental Health Reform says that the authorising officers must be available 24-7 in every county and I fully agree with that. In the run-up to the 2020 general election, I campaigned on the need for that kind of consistent and accessible mental health service and support. However this appears unlikely given the current under-resourcing of the HSE. We know there is a ceiling in place. In 2015, when the expert review group was formed only 100 officers were in place nationally and in 2020 the numbers had fallen by 20%. Nevertheless, I also note medical practitioners must assess patients within 24 hours of a request for involuntary admission being received and assessing officers must file the application paperwork within seven days. While the Mental Health Commission welcomes the explicit timeframes, the assessment of needs framework also comes with an explicit timeframe and this Government has been ignoring that since the day it passed. That needs to be said.

An aspect of the Bill I find particularly worrying are the sections authorising restraint and seclusion, including on children. The Mental Health Commission has been attempting to reduce restrictive practices in this country for more than a decade. The World Health Organization has been offering training for service providers working in the mental health space without relying on seclusion or restraint for the last five years, yet this Bill allows for the provision of restraint, seclusion and electroconvulsive therapies for children either under the age of 16 but admitted with parental consent, or over the age of 16 and admitted with or without parental consent. Guardians have to be notified but the phrase "as soon as possible" is used. If the World Health Organization considers these practices to be contrary to our obligations under the UN Charter on the Rights of Persons with Disabilities, why on earth are we codifying their legality?

This feels like a good time to point out, yet again, that the optional protocol to the UNCRPD has not yet been ratified although a commitment has been given to do so by the end of the year. This was given in February but I have still not heard any indication that this timeline will be adhered to. We live in hope, however, and we will wait and see over the coming weeks.

We would establish an individual complaints mechanism and make these binding obligations more accessible for people on the ground. This Bill does not have that independent mechanism and we still have not ratified the optional protocol. I have made the point time and again in this Chamber and since I first attended the disability matters committee in 2020 that the UN special rapporteur had pointed out that there was really no justification for the ratification of the optional protocol not being done at the same time and on the same day as the ratification of the UNCRPD, other than leaving those in need without access to an independent mechanism to be able to make complaints against injustices they feel they are experiencing, which is hugely important. That sends a clear message that there is no fear. People have the right to make complaints and there is nothing wrong with making complaints. That is something we could do with an awful lot more of in our society - that it is okay to speak up and speak out.

In general, the Bill is positive and I have heard the Mental Health Commission welcomed it, specifically the inclusion of the measure regulating CAMHS for the first time. That is something I have called for for some years and it is positive to see. While there is a chief inspector, the lack of an independent system is still a gap in the Bill. While the Mental Health Commission gave its approval of the Bill on Monday, it is my understanding that it did not have full access to the text. Perhaps the Minister of State can clarify that. Maybe full access has been given since, but that is an important point to note.

There are strong links with the Assisted Decision-Making (Capacity) Act's preference for independent decision-making assistance and the move away from paternalistic, best-interest models. The Assisted Decision-Making (Capacity) Act was passed in 2015 but only came into effect in 2022. It was, therefore, a seven-year process. The Mental Health Bill, like the Act, has been critiqued for not going far enough but there has been an indication that amendments will come forward. I hope they will address these missed opportunities.

I am aware that the heads of the Bill include concerning language. I refer to the reference to the word "disorder". That must surely be a mistake and it has to be amended immediately. I do now know how that was missed. Along with Deputies Connolly and Pringle and a few others, I attended Mental Health Reform's event with Jigsaw which focused on language and discussing mental health in a way that can reduce stigma, is in line with European best practice and also, very importantly, normalises access to services. In this House, we hear of very extreme cases. It was pointed out at the briefing that we should be more mindful that there are a large number of cases in the middle, that people have good experiences when they are accessing services and that it is okay to reach out as well. With all of that in mind, it might have been beneficial to have had someone from the Minister's office in attendance at the briefing because it is good to hear from those who know best. Síofra and Jack, who spoke on behalf of Jigsaw, outlined their experience of hearing triggering words and derogatory language being used when people are speaking about those who have mental health difficulties. As I stated, one in two people can be affected either directly or indirectly so we need to grapple with the kind of language we in this House all use when we discuss mental health. The Ombudsman for Children has also flagged this serious matter. I hope the commitment to bring forward more Government amendments is adhered to and that language is removed.

The timeframe of ten years for the review of the legislation is far too long because we know the period always extends for much longer than planned, so the timeline will probably be longer than ten years. I ask that the timeline be reduced significantly to ensure it is realistic and beneficial.

I also refer to the significant delays with the de-escalation service in Limerick. The service was supposed to open recently but is still delayed. It cannot be delayed any further. I cannot emphasise that point enough because there are so many people in need.

It is important to mention the mental health budget in recent years. The last time a double-digit percentage of the health budget went into mental health was in 1984. I know we have not been able to get that figure above 5% to possibly 6% in recent years.

I hope that the Department gets the budget it needs on 1 October, which will send a specific message to public bodies and local authorities, for example, so they can understand the importance of prioritising mental health and understand that they should not dismiss somebody when they say they are struggling and need help and support. I will also send a message to those who need to hear it that their mental health is a priority today. They have suffered many delays, but it will no longer be on the promise of tomorrow.

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